求一篇关于“血液净化”的英文文献，最好有7-8页那么长
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发布时间：2022-04-22 16:32
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时间：2024-12-11 17:07
Plasmapheresis is a separation, eliminate pathogens in patients with factor at the same time, health plasma and cellular components to lose in the method of treatment, to rece the harmful substances on the human body, pathological damage to the plasma in various functional recovery factor , the regulation of the immune. Apply to hepatic coma, acute rejection after organ transplants, myasthenia gravis and crisis, rapidly progressive glomerulonephritis, autoimmune hemolytic anemia, rheumatism, thrombotic thrombocytopenic purpura, and other.
Continuous renal replacement therapy is an effective clearance of acute renal failure in patients with excessive moisture, metabolic waste, and stability in the environment, improving the unstable hemodynamic conditions for a variety of treatment measures and the improvement of renal function protection is a variety of critically ill patients where necessary adjuvant therapy measures.
Hemoperfusion artificial liver is used, plasma exchange, hemodiafiltration, molecular immunosorbent assay, and other methods of removal of bilirubin, endotoxin, maintaining sugar, fat and protein metabolism, such as balance, stability, complexity of the human body for the environment system. Serious infections, endotoxemia, severe gastrointestinal dysfunction, acute poisoning, severe peritonitis, severe pancreatitis, severe multiple trauma (severe liver injury), causing liver dysfunction or failure, artificial liver support system in the treatment of the majority will tide over their difficulties in gaining a new life.
Specific adsorption bilirubin blood into the blood perfusion and adsorbent for full access, the use of bilirubin, the bile acid specific adsorption, removal e to liver failure resulting hyperbilirubinemia, mitigation condition , and create conditions for further treatment.
ICU has advanced plasma exchange, bedside continuous hemofiltration, and liver dialysis equipment, with a professional physicians and nurses to choose suitable for patients with the blood purification treatment modalities, 24-hour continuous bedside monitoring, critically ill patients with organ function to provide strong support for the rescue and treatment can win time.
血液净化治疗简介
血浆置换 是一种分离、清除病人血浆中的致病因子，同时将健康血浆和细胞成分输回体内的治疗方法，能够减轻有害物质对人体的病理损害，有助于血浆中各种因子功能的恢复，调节免疫。适用于肝昏迷、器官移植后急性排异、重症肌无力及其危象、急进性肾小球肾炎、自身免疫性溶血性贫血、风湿病、血栓性血小板减少性紫癜等。
连续性肾功能替代治疗 是一种能够有效的清除急性肾功能衰竭患者体内过多的水分、代谢废物，稳定内环境，改善不稳定的血流动力学状况，为各种治疗措施和肾功能的改善提供保障，是多种危重病救治所必需的辅助治疗措施。
人工肝 是采用血液灌流、血浆置换、血液透析滤过、分子免疫吸附等多种方法组成的清除胆红素、内毒素、维持糖、脂肪、蛋白质等代谢平衡、稳定人体内环境的复杂治疗系统。严重感染、内毒素血症、重度胃肠功能紊乱、急性中毒、严重腹膜炎、重度胰腺炎、严重多发创伤(重度肝损伤)等造成的肝功能不全或衰竭，应用人工肝支持系统治疗可使多数患者度过难关，获得新生。
特异性胆红素吸附 将血液送入血液灌流器与吸附剂充分接触，利用对胆红素、胆汁酸的特异性吸附作用，清除由于肝功能衰竭而导致的高胆红素血症，缓解病情，为进一步治疗创造条件。
重症监护病房拥有先进的血浆置换，床旁连续血液滤过、透析以及人工肝设备，配备有专业医师和护理人员，针对患者病情选择适宜的血液净化治疗模式，24小时不间断床旁监护，为危重症患者脏器功能提供有力的支持，为抢救和治疗赢得时间。
Using food "purify" the blood
Rection of food "to remove free radicals in vivo. Radical oxidation processes in the human body is a by-proct, it can damage the deoxy nucleic acid, collagen, destroy human tissue cells, a wrinkled, senile plaque, or even cause cancer, Alzheimer's and other disorders happen. to remove free radicals, should be more fresh food Rection ", spinach, leeks, pumpkins, onions, Shizijiao, tomatoes, carrots and other vegetables, soybeans, walnuts, peanuts, pistachios, cashews, pine nuts, almonds, and other hard foods, and brown rice, and other Zhuganshang. Vegetable variety of fresh vegetables was weakly alkaline allows blood to Shen in the cell to the toxin dissolved, with the urine excreted. Such as carrot can accelerate the excretion of mercury, garlic helps cobalt emit. Green leaves and stem of the best vegetable juice drink without boiling speculation. Haicai rich in glial kelp, penetrated the human body to accelerate the release of radioactive material. Invasive from mung bean can help in the various toxins, including heavy metals and other hazardous substances, and promote the body's normal metabolism. Mushrooms can purify blood, excretion of toxic substances. Regular consumption in the environment can be clean. Pig blood plasma protein contains a lot of pig blood, after human digestive enzymes and acid decomposition, and the gastrointestinal tract st, harmful metal particles, a chemical reaction, not easily absorbed into the waste was discharged. In addition, under normal circumstances, the human blood dominant slightly alkaline. If too many acidic ingredients, it will become a hotbed for various diseases. Fresh containing more than more basic ingredients and more food, in order to ensure the maintenance of blood Lue:pian alkaline normal conditions.
巧用食物“净化”血液
还原食物”可清除体内自由基。自由基是人体氧化过程中的副产品，它可损害脱氧核酸、胶原蛋白，破坏人体组织细胞，出现皱纹、老年斑，甚至引起癌症、老年痴呆等多种疾患的发生。要清除自由基，应多食还原食物”，菠菜、韭菜、南瓜、葱、柿子椒、番茄、胡萝卜等蔬菜，大豆、核桃、花生、开心果、腰果、松子、杏仁等硬壳类食物，以及糙米饭、猪肝汤等。 蔬菜 多种新鲜蔬菜可使血液呈弱碱性，让沉在细胞内的毒素重新溶解，随尿液排出体外。如胡萝卜可加速汞的排泄，大蒜则有助于钴的排出。绿叶根茎蔬菜最好榨汁饮用不经炒煮。海菜 含有丰富的海带胶质，可加快侵入人体内的放射性物质的排出。绿豆 能帮助排出侵入体内的各种毒物，包括各种重金属及其他有害物质，促进人体的正常代谢。蘑菇 能净化血液，排泄毒性物质。经常食用可净化体内环境。猪血 猪血含有大量血浆蛋白，经过人体胃酸和消化酶分解后，与侵入胃肠道的粉尘、有害金属微粒发生化学反应，变为不易吸收的废物而被排出。另外，正常情况下，人体血液中碱性略占优势。如果酸性成分过多，就会成为多种疾病的温床。多食以上含碱性成分多的食品，以保证血液维持在略偏碱性的正常状态。
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时间：2024-12-11 17:08
Shanghai Jiaotong University College of Medicine subsidiary Ruijin Hospital kidney Chen Nan-J) N FWR; t
Blood purification technology in clinical treatment of acute and chronic renal failure has been nearly half a century, and in critically ill patients, such as acute renal failure (ARF) in the treatment of continuous renal replacement therapy (CRRT) more traditional intermittent hemodialysis greater advantages, its clinical application is graally expanded from the traditional kidney renal replacement to support development, participate in a multidisciplinary critical severe rescue. _ (HwU>.
Whether or ARF in patients with CRF usually kinds of medication, drugs in the application of these patients should be in accordance with its resial renal function adjustment, and at the same time, blood purification and changed the drug metabolism in patients with these conditions, particularly in critically ill patients, such as failure to consider this factor, medication adjustment programmes, the consequences could be unthinkable. Q: bKT # \
1) from the following three aspects of the assessment of patients with blood purification pharmacokinetics. P (rS - `I
First, the nature of drug j1ZFsTFMWp
1, renal clearance in the proportion of drug: drug in the body's overall clearance rate is the body organ system capacity to remove the sum of drugs, including liver, kidney, as well as other metabolic pathways. If drugs mainly through kidney removal, which is usually to remove CRRT part of the in vitro clear / removal of the overall ≥ 25 ~ 30%, it is necessary to adjust the dosage. Pio ^ 5j hB6
2, protein binding rate: drug free with biological activity and can be removed filtration, plasma protein binding is the high rate of drugs (such as digitalis glycosides drug, warfarin, etc.) are difficult to remove CRRT. Protein binding rate can be affected by many factors, the theoretical value and the actual situation may have some differences. ! A! \ S / x4
3, molecular weight: small molecular diffusion easy to be adopted by dialysis membrane pore, drug removals and molecular size inversely proportional to macromolecules often convection through, unless more than its molecular weight film hole size, or ultrafiltration rate associated with the removal. Most of the molecular weight of less than 500 drug Da, Da little more than 1500. Extension of high-flux dialysis membrane and time of removal can be improved more. 'T [zh # v> S
4, the volume of distribution (Vd): in vivo drug representatives of the extent of the distribution. Vd representative of the high rate of drug organizations with high clearance rate is low. Vd patients with severe and theoretical value can be very different, but there are indivial differences. Drug Vd ≤ 1 L / kg easy clearance, ≥ 2 L / kg difficult to be cleared. High flow could be higher IHD Vd drug rapidly cleared from plasma, serum concentration decreased, but only in a dialysis drug remove a small part in the two dialysis between plasma concentration will quickly rebound. CRRT continued slow clearance high Vd drugs, the process of drug plasma from the organizations to re-distribution, the change in the plasma concentration of small. (<KG (i /
5, drug charge: Chang adsorption anionic membrane filtration, with negative charge, with the drug charge is reced filtration, and negatively charged drug filtration rate increase. U3) ~ R ^ W eb
6, drug screening factor: that filter out of the drug concentration / plasma drug concentration in plasma for the evaluation of the drug combination percentage, mainly associated with the protein binding. Screening of the coefficient close to 1, that drug can be almost entirely through membrane filter out. + & OqJAu
Second, dialysis and purification methods for Nd! + VR IZ
1, including the principle of blood purification three ways: diffusion, convection and adsorption. Diffusion most basic test of dialysis, dispersion of small solute clearance more effective, and the removal of macromolecules through convection. CRRT, ultrafiltration rate determines the solute clearance rate. And membrane on both sides of the concentration of solute unrelated, and only the size of the membrane pore size. Adsorption can increase the plasma solute clearance, different filter different adsorption capacity. But there is a saturation adsorption process, it depends on the number of drug remove the frequency of filter replacement. Usually 18-24 hours on the use of filter no role in the adsorption. II * 7WO [W
2, the choice of dialysis machines include: the membrane pore size, ultrafiltration coefficient, surface area is the impact of the removal of several major drug one of the factors. Ultrafiltration coefficient is high and the membrane pore size can be more convection remove the larger molecular weight of the drug. G + uiZ (p>
3, blood and dialysis fluid flow rate: the faster the velocity, the more easily access drug dialysis membrane into the dialysis solution in the dialysis fluid flow faster, drug dialysis fluid outflow from the faster to maintain the required gradient diffusion. # J a `+ w)
Third, the patient's own | (a] P = <q
Many factors can change the plasma protein binding, such as PH, heparin treatment, hyperbilirubinemia, free fatty acid concentrations, hypoproteinemia, uremia and other metabolites could affect protein binding. Different disease will change drug Vd, screening coefficient, the rate of ultrafiltration. Z U ~ ..; C
2) the removal of drugs and drug dose assessment (0 W) e (D 8
Hemodialysis drug remove the two pharmacokinetic model: steady-state model and volatility model, through its dialysis to judge whether they need to adjust regimen, drug dosage can be adjusted by changing the medication or change the dose intervalto carry out. Also, if dialysis purpose is to eliminate excessive drug in dialysis must be more than a half-life. AMQjoam z
In the post-dilution method Hangxie filter, removing the main drug to convection. Ultrafiltration drug clearance rate = rate × (1 - protein binding); before dilution method Hangxie filtration, ultrafiltration drug clearance rate = rate × (1 - protein binding) × blood flow / (+ replacement of blood flow volume ); should add drug dose = concentration difference (drug concentration required to achieve - the measured concentration) × Vd × weight of the law to the actual determination of drug concentration. Actual clinical work, it is proposed that CRRT therapy, how to adjust the dosage, to make full use of information about the reference. If George RA waiting for the "drug dose dialysis patients" (Dialysis and Transplantation Philadelphia. WBSauders Company.2000.358 ~ 372), many of the normal drug pharmacokinetics data, and dose adjustment proposals put forward CVVH. It is recommended that the use of GFR as a reference for the CRRT GFR10 to 50ml/min as kidney removal of the drug, but patients with severe acute certain errors may exist. Table 1 Nephrology commonly used drug pharmacokinetic parameters and to adjust HD and CRRT (reference since George RA waiting for Drug dosing in dialysis patients). V: BX "$ J1
Table 1 drug used by kidney pharmacokinetic parameters and to HD, and CRRT adjustments l & *) r 9
_i The name of the drug half-life [) $ EgFm
(H) protein binding rate * xg `Kwl5Kl
(%) Vd JhC k k w
(L / Kg) renal 3; MjO *-
After the normal dose HD R (X -82%
SUPPLEMENTARY of CRRT 8a `+ h #
Dose adjustments] 1d, O ^ S
Penicillin V 0.6 50 ~ 80 0.5 0.25 q6h thoroughly after delivery without adjustment q | o | / O-(
Amoxicillin 1 15 ~ 25 0.26 0.25-0.5 q8h thoroughly after delivery without adjustment (HH hK
Cefazolin 2 80 0.13-0.22 0.5-1.5 q6h 0.5-1 0.5-1.5 q12h. S!> 9X,
Cefaclor 1 25 0.24-0.35 0.25-0.5 tid not adjusted to 0.25 sU? "V
Cefoperazone 1.6-2.5 90 0.14-0.20 1-2 q12h thoroughly after delivery without adjustment?,: # 8.9
Cefuroxime 1.2 33 0.13-0.18 0.75-1.5 q8h thoroughly after administration 1.0 q12h * i? RJH
Ceftazidime 1.2 17 0.28-0.4 1-2.0 q8h 1.0 1-2.0 q24-48h YxE bg (Y
Amikacin 1.4-2.3 <5 0.22-0.29 7.5mg/kg q12h 2 / 3 of the normal 30-70% q12-18h wI! + L & Q
Tobramycin 2.5 <5 0.22-0.33 1.7mg/kg q8h 2 / 3 of the normal 30-70% q12h lC = N: = Mu
Ciprofloxacin 3-6 20-40 2.5 0.5-0.75 q12h 0.25 q12h 0.2 q12h, $ h (fM8GC
Levofloxacin 4-8 24-38 1.1-1.5 0.5 q24h 25-50% 50% + T, H & #
Imipenem 1 13-21 0.17-0.3 0.5-1.0 q6h thoroughly after administration 50 percent - J "qrp Z ^
Vancomycin 6-8 10-50 0.47-1.1 0.5 q6h 0.5 q48-q24-96h 0.5% 48h c X:
3 30 0.4 losartan 50mg qd-q12h unclear hundred percent jq57C)) X 2
Benazepril 22 95 0.15 10mg qd not 50-75% uw K h
Monopril 12 95 0.15 10mg qd not 100%. [T'yc: =
Atenolol 6.7 45-60 5-10 50-100mg qd 25-50mg 50% q48h s ULIrYRA
The name of the drug half-life F Ze: co8Mu
(H) protein binding 0zw + @ l `
(%) Vd `" a? A 5] k
(L / Kg) renal function f) .* NX
After the normal dose HD ^ fs m6 f))
SUPPLEMENTARY of CRRT j ~ Q) F | i8
Carvedilol 5-8 95 1-2 25-50mg q12-24h not 100 percent [6AHaOhR '
Nifedipine 4-5.5 97 1.4 10-20mg q6-8h not 100%> s & XX, w
Amlodipine 35-50 95 21 5mg qd not 100 percent 1p8: 1) q
Felodipine 10-14 99 9-10 10mg qd not 100% gs? 8Wzh90 *
Digoxin 36-44 20-30 5-8 0.25-0.5mg qd not 25-75% q36h H4t) + (: D '
Low-molecular-weight heparin 2.2-6.0 unclear 0.06-0.13 30-40mg bid unclear 100% p "2m9 0IO
Warfarin 34-35 99 0.15 load 10-15 mg of 2-10 mg qd not iHPUmTus not --
Azathioprine 0.16-1 20 0.55-0.8 1.5-2.5mg/kg q24h 0.25mg/kg 75% yq?] V7 ~
Cyclophosphamide 4-7.5 14-20 0.5-1 1-5mg/kg qd 1 / 2 dose of 100% Z:! IX ^ q;) n
Vincristine 1-2.5 75 5-11 1.4mg / sq m unclear 100% I! P4 (3skAB
Prednisone 2.5-3.5 80 2.2 5-60mg qd not 100% X x_ tpC?
Prednisolone 2.5-3.5 80 2.2 5-60mg qd need 100 percent OZf6/10O /
A prednisone 1.9-6.0 40-60 1.2-1.5 4-48mg qd not 100 percent [@ / /) # 5v
Insulin 2-4 5 0.15 Indefinite not 75% `([R j M`
Acarbose 3-9 15 0.32 50-200mg tid unclear avoid / 'ZKST4
Effects of Fluvastatin small 0.5-1 98 0.42 2-10mg qd unclear 100% k O1)? DWpa
Simvastatin 2> 95 mg qd unclear 5-40 unclear 100%
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时间：2024-12-11 17:08
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